Morton neuroma

This patient’s presentation is consistent with Morton's neuroma (interdigital nerve compression).  This condition is common in women who wear high-heeled shoes, runners, and people with flat feet.  Repetitive injury leads to painful enlargement of the plantar digital nerve between the metatarsal heads.  Patients complain of numbness and burning pain.  Pain is located along the plantar aspect of the forefoot, usually between the 3rd and 4th metatarsals.

The diagnosis of Morton neuroma is primarily made clinically. On examination, squeezing the metatarsal joints will cause pain on the plantar surface of the foot along with crepitus between the third and fourth toes (Mulder sign).

Treatment involves conservative measures such as orthotic footwear (metatarsal support with a bar or padded shoe inserts to decrease pressure on the metatarsal heads) and NSAIDs.  Corticosteroid injections can be used for symptomatic relief in patients who fail conservative measures.  Surgical excision can be performed for patients who fail all such therapy and remain symptomatic after 1 year.

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